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General NPI Number Information
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NPI Number | 1487384855
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Entity Type | Individual
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Provider Name | CAROLYN BAILEY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 3100 KILPATRICK BLVD STE 100
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City | MONROE
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State | LA
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Zip | 71201-5156
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Country | US
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Telephone | 318-325-8050
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Fax | 318-325-5385
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Provider Business Mailing Address
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Address Line | 3100 KILPATRICK BLVD
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City | MONROE
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State | LA
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Zip | 71201-5156
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Country | US
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Telephone | 318-350-9582
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Fax | 318-325-5385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 226140
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License Number State | LA
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